Print out this form to apply for employment at:
Little Bears Pre-School
6975 Hwy 70
Bartlett, TN 38133
901-373-8687
APPLICATION FOR EMPLOYMENT
Date________
PERSONAL DATA
Name in full ______________________________________SS#___________________
Complete Home Address__________________________________________________
Phone#____________________Emergency Phone#_________________
Cell Phone# _________________Date of Birth__________________
Position Applied for ________________Mornings____Afternoons_____Flexible____
Marital Status_____#r of Children____Ages of Children_______
Spouse’s Name____________________Employer_______________Phone#_______
Are you legally eligible for employment in the United States? Yes_____ No________
Would transportation to and from work be a problem for you?___
What brought you to this center?____________________________________________________________
Do you have any relatives at this center?________If so, give names_____________________________________
When could you start work if hired?___________
Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied?
Yes____No_____ If yes explain ____________________________________________________________
_____________________________________________________
What special qualifications or hobbies do you feel would be helpful in this position dealing with children?_______________________________________________________
_______________________________________________________
Explain why you want to work with children in a daycare setting._________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
EMPLOYMENT HISTORY
List most recent job first.
Place/ Position /Job Dates /Reason for leaving
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
EDUCATION
Name of High School you attended___________________
Location_______________
Did you Graduate?_______What Year?________ GED?________
College or University attended____________________
Location_______________
Years attended__________Did you graduate?__________What year?____________
What was your Major?________________If hired we will need documentation of your educational experience.
List all other educational experiences, training programs, workshops, courses, conferences, Sunday school teaching etc._____________________________________________________
_________________________________________________________
_________________________________________________________
PHYSICAL RECORDS
Do you have any health problems that might keep you from performing the everyday jobs in a child care center?_____ If yes, explain____________________
____________________________________________________________
List all serious illnesses and major disabilities or injuries sustained over the past five years. ____________________________________________________________
Have you ever received Workmen’s Compensation benefits? ____ Dates_________ Were disabilities involved?________ __________________________________________________________
How much time have you lost through illness in the past 2 years?_______________
Do you have any physical disabilities at the present time?__ If so, what are they?
____________________________________________________________
What is the present condition of your health? _____________
Your Physician’s Name____________________Address_____________________________
Phone#________________Date of last physical____________
Date of last TB test____
If a license is required for the position for which you are applying (drivers or others) please list the following:
License Number and Type:____________
State which license was issued___________
REFERENCES
List at least 5 references, including all former employers. Other references may included business or personal character references. Do not include relatives.
List Name / title / Address/ Phone# /years known
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Have you ever been convicted of a felony, including anything involving a suspended sentence?_____If so, what and when?___________________________________________________________
Have you ever been reported for child abuse or neglect?____ If so, where and when?
____________________________________________________________
Tennessee State Regulations for Day Cares TC 14-10-129 states that “each person applying to work with children as a volunteer or as a paid employee. Shall complete an application on a form prescribed or approved by the Department of Human Services. It shall be unlawful for any person to falsify any information required on the application. Knowingly failing to disclose required information shall be deemed to be falsification to the same extent, as providing false information.” I fully understand that any misleading or incorrect statements may render the application void and would be cause for immediate dismissal in the event of employment. The applicant agrees to furnish such additional information and obtain such medical examinations as may be required to complete his/her employment file. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant. It is agreed and understood that if hired, the employee may be placed on a probationary period during which time he/she may be discharged without recourse.
By signing this form, I am affirming that the above statements I have made are true and factual to the best of my knowledge: and I am granting permission for all persons, organizations, or agencies listed on this application to be contacted for the expressed purpose of pre-employment screening. I hereby certify that all the information on this application, my resume, or any supporting documents is correct and I understand that any misrepresentation or omission of any information will result in disqualification from consideration for employment or, if employed, my termination. I understand that this application is not a contract, offer or promise of employment. If hired, I will be able to resign at any time for any reason, likewise, the company can terminate my employment at any time, with or without any reason.
I authorize the company or its agents to investigate all statements contained in this application and / or resume. I further understand that a credit and background check may be conducted. I hereby authorize my former employers, educational institutions or individuals named to furnish all information pertaining to my work or educational record. I release my former employers, education institutions, supervisors, co-workers and references from all liability.
I understand that as a condition of employment I may be required to sign a non-compete agreement and / or conflict of interest statement., I understand that my employer has a drug-free work place which includes a post-accident drug testing program. I also understand that all employees of the location may be subject to urinalysis and / or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If detected, and offer of employment and I agree to undergo random, fitmess for duty, return to work and reasonable suspicion alcohol and drug testing. Refusal to take such tests when asked may result in termination. I understand this company hires only U.S. citizens or individuals who are legally eligible to work in the United States.
This application is current for thirty (30) days. At the conclusion of this time, if you have not heard from the Employer and still wish to be considered for employment it will be necessary for you to complete a new application.
Applicant Signature_________________________________________Date______
Applicants will considered without discrimination because of race, color, sex, age religion, national origin, marital status, disability, or veterans status. ISSI also provides reasonable accommodations for qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADS) and applicable state and local laws.
Little Bears Pre-School
6975 Hwy 70
Bartlett TN 38133
